Sciatica: Lumbar Radiculopathy
The term sciatica stems from the name of the nerve of which it effects. The sciatic nerve exists bilaterally in the body from a bundle of nerves that exit the spine on the five levels from the L4-S3. Each of these five bundles travel through hip and come together into one very thick nerve deep in the buttock. Each of the bilateral sciatic nerves then travel down the leg of the body on their respective sides and provide sensation throughout the leg and into the feet. The condition of sciatica blankets nerve impingement of all natures and positions along the sciatic nerve. The classic symptoms of sciatic include radiating pain, numbness, or burning, that travels from the low back, hip, or buttock, down the leg and possibly into the feet.
What is Sciatica?
If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have sciatica. Sciatica occurs when physiologic conditions apply pressure to the sciatic nerve which in turn presents to you with radiating pain or numbness from in all or parts of the region from your lower back to your feet.
Causes of Sciatica
Sciatica has many causes, but usually presents during midlife between the ages of 30 to 50 years old. Compression of the sciatic nerve causes irritation that interferes with normal nerve conduction and presents as radiating pain, numbness, tingling, or a burning sensation. The compression of the nerve can occur in the spinal canal or in the nerve root. Commonly the cause of sciatica includes lumbar spinal canal stenosis, lumbar spine foraminal stenosis, degenerative disc disease, spondylolisthesis, facet joint arthritis, piriformis syndrome, and even pregnancy.
Lumbar spinal stenosis– the most important part of your nervous system includes your spinal cord. Rightfully so your body has a natural armor to protect it composed of the bones of your spine. Inside of this protective bone complex exists a canal in which your spinal cord travels through. A few unfortunate people are born with defects that narrow this space, and others succumb to this space narrowing over time from the wear and tear of aging. When the space narrows too much the spinal cord becomes compressed, and in cases where this compression occurs in the lumbar spine the effects present as stenosis.
Degenerative disc disease – as we age the cushions between our vertebral bodies desiccate. Unfortunately, the compounds contained inside of the discs require water molecules to maintain their volume. As the internal pressure of the loss of volume decreases the discs increase their brittleness and are may slip out of place, displace weight unevenly, or even rupture and spill their inflammatory contents all over your spinal cord or nerve roots. Shape changes in the narrow space of your body can cause nerve compression leading to stenosis or lead to arthritic conditions that ultimately lead to stenosis or other disorders. Inflammation from disc contents may temporarily cause nerve compression from the inflation of tissues, but often responds well to steroids and only requires surgery in a small percentage of patients, usually from unrecoverable structural changes.
Spondylolisthesis – A series of forces and structures hold your spine in place. The bones act as rigid structures to bear most of the weight of your body. The discs protect the bones from crushing each other. Joints exist between each vertebra to allow movement. Ligaments bind the bones and joints together. Muscles hold the bones, discs, and ligaments in place while allowing for complex movements. However, in some people the supporting structures fail to protect the bone and it may incur damage. Sometimes this damage allows the bone to move in an unnatural horizontal plane. When your vertebra slips forward or backward the spinal cord gets pinched. This pinching can cause sciatica in mild cases.
Facet Joint Arthritis – the facets joints exist between vertebral bodies to allow the spine to bend while maintaining control to protect the spinal cord. Many issues can cause the degradation of the cartilage in the facet joints and ultimately lead to foraminal canal narrowing that pinches the nerve roots exiting the spine.
Piriformis Syndrome – Piriformis syndrome occurs when you aggravate the piriformis muscle in your buttock. Muscles spasms and inflammation can potentially compress the sciatic nerve.
Pregnancy – Unfortunately, yet another potential side effect of the amazing wonders the human body withstands during gestation includes compression of the sciatic nerve. We love you moms; thank you for everything.
Symptoms of Sciatica
Sciatica typically affects only one side of the body, often originates in the lower back, and then travels down through the leg and may stop at the calf or even the toes. You may have pain, especially when you sit, sneeze, or cough. Muscle weakness may present in severe cases; if you have muscle weakness call a spine surgeon immediately. Pins and needle sensations may occur, numbness, tingling, or even burning sensations are common.
The most common symptoms of sciatica include:
- pain the buttocks or leg that gets worse with sitting
- weakness, numbness, or difficulty moving the leg or foot
- hip pain
- burning or tingling down the leg
- lower back pain
- shooting pain down the leg
Diagnosis and Treatment
Properly diagnosing sciatica requires finding the source of the cause of the nerve impingement. Many times, the cause responds well to conservative treatment while other times it may require surgery. However, regardless of the cause you should seek treatment immediately if you experience sciatica. Rarely will it get better on its own and nerves may sustain long lasting if not permanent damage if compressed for too long.
